Through a window and over a roof - the remarkable challenges Swansea Bay's capital planning overcame during £7.7m Morriston Hospital project

Swansea Bay University Health Board’s Capital Planning team are well used to managing complex building projects but few have presented more headaches than a two-stage £7.7m upgrade to Morriston Hospital’s burns service facilities.

For starters, site access for the first stage had to be through a window and across a roof. For the second, 20 tonnes of ‘spoil’ was removed using Morriston’s main corridor. Work on both stages had to be adapted and painstakingly managed to ensure there was no disruption to patients and staff in a busy working hospital.

Stage one involved integrating burns services with the intensive care unit, creating three highly-specialised burns cubicles with en-suite showers and sophisticated temperature control systems. Two additional general intensive care cubicles were also included.

Stage two saw the expansion and complete refit of an existing operating theatre to adapt it for specialist burns use.

This second element required the construction of an extension to create a larger theatre area and provide space for a re-routed corridor and new changing area.

Remarkably given the huge challenges involved, the project, funded by Welsh Government, was completed on time with ‘zero defects’.

Picture: A red arrow points to the window used to gain access to the site

But all this is nothing new to Swansea Bay’s Capital Planning team, who face challenges of this nature daily in their work to carry out vital developments and improve and maintain approximately 250,000 square metres of health board sites.

 “In the early stages of the project, staff asked if work was being undertaken as they were unaware of progress due to the lack of noise and disturbance.  It was pleasing to hear that no disruption was being caused,” said client project manager Ben Mullock.

“It became apparent that the clearing of the existing Intensive Care Unit north area and removing everything via existing access routes was impossible. At design stage, it was decided that access would be through a window in ICU and everything would be taken across the roof and lowered to a designated area. This access route was used during 90 per cent of the construction work. But due to working within healthcare settings, we are used to finding alternative solutions to challenges.

“Because of the needs of service users elsewhere in the ICU, we had to ensure that we maintained segregation whilst work was undertaken for Infection Control and Prevention.

“During the later stages of the scheme, in conjunction with key stakeholders, it was agreed we were able to bring doors and pendants through the main building, during early mornings or late at night due to the size of these items and the need to avoid busy periods.”

Three shower areas were added above the Emergency Department, which meant gaining access via ED resuscitation area.

“A plan was formed with key stakeholders, hospital management and ED staff to accommodate these works. As a result, resus was re-located for 12 hours midweek. This was a success due to the significant planning and collaboration from all involved.”

Despite all the obstacles, the new burns cubicles were completed on time and were unveiled in September, when Cabinet Secretary for Health and Social Care, Jeremy Miles, paid a visit to Morriston to see the impressive results of all the hard work.

This was only phase one of the work, with Phase 2 providing a new operating theatre suitable to treat burns patients.

This entailed upgrading the old operating theatre 7, situated along a corridor from the ICU. The work on this element of the project was also completed on time ahead of the theatre opening on January 8^th this year.

“Phase 2 required an extension in order to create a new corridor and female changing area due to the expansion of the existing theatre space” added Ben.

“A new air handling unit was required, which is sat on top of the extension. This came with challenges due to the dimensions - it is ten metres long. This meant that everything had to come flat packed due to the logistical challenges.

“Access and egress for the works undertaken in the theatre had to be via the main corridor and using the lift, ensuring no impact to the day to day running of the hospital. Adequate planning was required to minimise disruption, focused on early mornings and weekends and in collaboration with colleagues. This was a very time-consuming process.

Pictured: The new extension, which has created extra room for the expanded and re-fitted theatre.

“The recovery area is also adjacent to the theatre work, so we expected delays due to the construction noise, but this was well controlled. It was vital to keep the dust to a minimum. Strict infection prevention and control guidelines had to be adhered to and keeping IP&C team closely involved.

“A recurring theme throughout the project was communication, collaboration and working as a team to get the work completed in a timely manner with minimal impact and disruption on our colleagues and service users.”

“The contractor, T Richard Jones has a vast experience of working within hospital environments, which ensured that the schemes were managed appropriately.”

While all the hard work and planning was extremely challenging, Ben, his capital planning colleagues and the contractor have all been delighted by positive feedback from colleagues who are now benefitting from the development, which appropriately coincides with the 30^th anniversary of Morriston’s Welsh Centre for Burns and Plastic Surgery.

“It’s been great, there was so little disruption and working day-to-day in the new environment is so much better,” said consultant intensivist and ICU lead for burns, Dr Nia Davies.

“Ben kept us in the loop throughout the process. It’s a great example of collaborative working – it worked so well and we very much felt part of the process.

“If we’ve had an issue, it’s been addressed swiftly. We had some questions around the temperature control, for example, but they were sorted out very quickly.

“Facilities in the burns ICU are now as good as anywhere else in the UK, it is fantastic for our patients. We have a much better use of space and it means the various disciplines (burns, intensive care and anaesthetists) can now get together regularly. Before, trying to get 20 people together at the same time was really challenging.”

Jeremy Yarrow, lead surgeon for burns, has been equally delighted by the theatre.

“It’s a brilliant facility and the level of planning and the challenges faced by Ben and the contractors underlines how difficult it is to work in a working hospital environment,” he said.

“The theatre is exactly what we need. There’s no clutter, it’s a minimal environment and very easy to clean and maintain. These are all big priorities when treating burns patients, so we’re delighted.”